[New and old glucose lowering drugs; a state-of-the-art review]

High glucose values are associated with vascular risk in observational studies, but glucose lowering does not automatically translate into better outcomes for patients In patients with type 2 diabetes and cardiovascular disease, cardiovascular benefits of GLP-1 receptor agonists and SGLT-2 inhibitors have been demonstrated. However, experience in clinical practice is limited and costs are high. In diabetic patients with heart failure and renal complications, SGLT-2 inhibitors may have additional beneficial effects. Metformin may have vascular benefits, but this has not been demonstrated for sulphonylurea derivatives, insulin and DPP-4 inhibitors In patients with a low cardiovascular risk, beneficial vascular effects of glucose lowering drugs have not convincingly been demonstrated. The outcomes of the recent studies will lead to a more personalized treatment strategy for type 2 diabetes. Treatment choices will depend upon patient's risk of complications, the goal of therapy, patient preferences and costs.